Tightrope

Dear Dr., I feel I am in hell and I need your help.

Three years ago I met a wonderful guy who had a generous heart and who was very kind, sensitive, responsive and attentive to me. Shortly after we met he told me his father was dying of untreated colon cancer at the age of 43 (he also suffered from schizophrenia). For the first few months of our relationship, it was very rough for us because we would drive 4 hours away three or four times a week to visit his father in hospice. However, I loved him and I was going to help any way I could. I was devoted.

We went through this for about 5 months before he passed away. It was very difficult, as you can imagine, for my boyfriend at the time. He was barely 22 and lost his father. This was when I started noticing he had anger problems. He would act violently, yelling and cursing and accusing me of cheating (when I was not), and yet other times he would come home with roses for no reason. His mood swings became a daily tightrope for me to walk on, holding my breath, waiting to be sad or happy.

Before his father died, he was not romantic, not unromantic, he was just himself. He had his romantic moments, and his rude ones, but he was generally a level person.

After his dad died, he was volatile and accusatory or elated and happy.

Right before his dad died, we moved in together, so we were getting pretty serious. He bought me a promise ring a few months after that. Despite these things, our relationship continued to deteriorate. He continued to be mean (name calling), to be paranoid (accusing me of cheating), to be violent (yelling, breaking things), and he eventually started cheating as well.

I did not know about the cheating until almost 1.5 years into the relationship. He had been cheating for 3 months or so.

I tried staying, but I just couldn’t. I loved him, and I forgave him, but it was too difficult a situation. I moved out, and didn’t speak to him for a very long time.
Months passed, and eventually we were casual friends (texting every other week to say hi). Later, we started spending time together, like going to see movies or going to dinner. After about 6 months we started sleeping together again.

He wanted to date me, but I told him that I wasn’t going to date him. I felt he had no remorse or guilt, or any indication that he felt bad for the things he’d done or said to me, and I wasn’t about to let it happen to me again.

He was not okay with the arrangement, but he didn’t complain because he was just happy to have me in his life. In fact, he seemed really ecstatic to have me in his life. He became clingy (he surely never was before), calling repeatedly, texting repeatedly, begging to spend time with me.

We did spend time together, but apparently not enough. I work and go to school, and he works night shifts, so we only spent one day a week, or less, together.
I started getting nervous about his clingy aspect. Then he started getting even weirder.

He started out by telling me I had done something that I hadn’t done. He claimed he’d seen me do it. Later, he claimed he remembered meeting a guy with me, though the event, time, place, and person that he was referring to didn’t ever exist.

At first I thought he was just having memory problems, or he was trying to make me mad.

So I ignored it. Until his mother called me in the middle of the night about a week later saying he had called her and told her psychotic, unrealistic things. As an example, he claimed that he and I had both been drugged and raped by the stepdad and the dog, at Christmas the year before.

There is no way that happened. I don’t even have to write out the list of all the reasons why that doesn’t make any sense.

After I received her call, I initiated contact with him. I asked to see him and when we hung out it was as if he was a different person. His eyes got huge as he was telling me off the wall things. He told me the DA was going to have him arrested and she calls him in the middle of the night. He told me that his neighbors had purchased listening devices to listen to him masturbate in his apartment. He claimed that a “bad guy” was framing him for murder and had pictures of his truck at red lights from camera snapshots and they matched up with the times of the murders, and that he was going to jail.

In addition to all of this, he told me he’d raped and murdered people in his past. (It’s possible, but highly unlikely).

He got worse and worse until I took him to the ER for a psychiatric evaluation. He saw two different psychiatrists and the diagnosis was schizophrenia.
They gave him a sedative and released him. The next day, he accused me of trying to have him committed so I could steal his things. I tried to tell him I just wanted to help him, but he just continued to accuse me so I left his house. As I was driving away and crying (because he’d yelled and screamed and said hurtful things), he called me on my cell phone. Very nonchalantly he asked me if I wanted to hang out. Of course I did not.

I did check in on him once a week to make sure he made it to his weekly appointments with a psychiatrist at a schizophrenic-specific center I’d gotten him connected with. After two visits, he never went back. He refused treatment for counseling and medication for ridiculous reasons, like the medication was to brain wash him, or erase his memories.

For weeks I continued to stay distant, until he started being nice again. I did not sleep with him, and I made it very clear that we were not together, that we were friends, that was final.

He was very upset by this, even though weeks before he’d told me he never wanted to see me again, and he became clingy and needy.
We spent time together platonically, a few times per week.

About a month ago he called me, enraged that I wasn’t going to date him. I reiterated why, that he would need to change, but he didn’t seem to understand what I was saying. Once again, he started saying random, accusatory things against me. He said extremely hurtful and derogatory things to me.
So, finally, here are my questions.

How can you convince someone with schizophrenia that a) they have schizophrenia and b) they need treatment?

Are these mood swings normal in people with schizophrenia? How long do they normally last? Can he ever live a normal life without treatment?

I am worried because this is the longest amount of time he’s been rude to me. Each time I call him, he doesn’t answer. He doesn’t respond to my text messages. Should I just walk away, or should I wait for him to stabilize?

His mother and sister (his only family) live in another state. Despite the encouragement of the psychiatrist, and my urging, they did not come to see him, or offer to have him with them for any amount of time. His mother simply said “commit him, it will be easier and take less time.”

I feel like I am stuck in a hard place. Do I walk away from someone who I’ve loved and cared for because it’s detrimental to my health as well? Or do I stay because he has no support and it’s the right thing to do?

Will he ever forget the delusions he created and see people who they really are, or are the delusions something they believe for the rest of their lives?

If he holds on to these delusions for life, then he will continually hate me for things I never did. It would only be detrimental to be his friend in this instance, right?
Please help. I don’t know what to do. I love him, and I care for him, but I don’t know what’s right and wrong in this situation. What’s the best thing to do?

Thank you for providing a great amount of detail with your question. The more information provided, the better able I am to answer your questions.

An “easy” way to think about the situation is this: if you had two children and one was destructive, dangerous and a threat to the other, doesn’t the innocent child have the right to be protected? The answer is yes. You would have no choice but to do whatever was necessary to protect the innocent and vulnerable child from the potentially dangerous child. Think of yourself as the innocent and vulnerable child. You have to protect yourself. It is not selfish to want to protect yourself. No one else is going to do it. It is necessary and it is simply an act of self-preservation.

It is also important to view this situation from the proper perspective which is that your boyfriend is mentally ill. “Normal” relationship standards no longer apply. He may be capable of having a healthy relationship in the future but at this time he can’t. I understand that you love him and don’t want to leave him but love cannot cure schizophrenia. Only treatment can and at this time he is not willing. This is the reality of the situation.

At this point in time, I believe that your boyfriend has the potential to be dangerous. There are multiple reasons why this may be true. One is that he’s constantly accusing you of having an affair. If he truly believes that you are betraying him, then he may become upset and want to retaliate. Other major “red flags” include the fact that he won’t take medication, he’s actively psychotic, he refuses all treatments, both his behavior and mood are unpredictable, he has a history of violence and abuse toward you, he shows no remorse for that abuse and he claims that he has murdered individuals in the past. He is very unstable and unpredictable. This puts you in danger. Individuals with schizophrenia are typically not dangerous but under certain circumstances they can be. In addition, when individuals with schizophrenia are violent the violence tends to be directed toward their family members. You are at risk.

To answer your specific questions, can you convince someone with schizophrenia that they have the illness and that they need to be in treatment? In approximately half of the cases, individuals with schizophrenia recognize that they have the illness and they need to be in treatment. The remaining 50 percent do not recognize they have a mental illness and will not engage in treatment due to a condition called anosognosia. Individuals who lack insight into their illness have a worse prognosis than individuals who have insight. Here’s a link to a previous answer I provided to a similar question that further discusses anosognosia.

Individuals who do not recognize their illness have the potential to eventually accept treatment but in many cases this does not occur. You may benefit from contacting the National Alliance for Mental Illness (NAMI). Many of the members have years of experience dealing with the exact issues you’re facing. They are a great source of information, support and practical advice.

You asked whether mood swings are common among individuals with schizophrenia and if so how long do they normally last? Mood swings can occur with schizophrenia and in particular schizoaffective disorder (a variant of schizophrenia) but they are more common among individuals with bipolar disorder. How long they last depends on whether the individual adheres to treatment. With the proper treatment, mood swings can be decreased or eliminated. Without treatment, they may continue unabated.

Your final question is: Can he ever live without treatment? The research shows that the majority of people with schizophrenia require some form of treatment in order to stabilize. Studies consistently show that individuals who do not adhere to treatment have more psychotic relapses and generally never fully stabilize. Treatment is the best way to prevent future relapses.

I understand that ending your relationship may be one of the most difficult choices you will ever have to make. Try to help him in any way you can but when you’ve exhausted all options you must stop before it becomes a detriment to your life. I would never advocate ending a relationship with someone who is mentally ill simply because they are mentally ill but you can’t abandon your life to save someone who may not be capable of being saved. The choice that you are facing is one of the ultimate tragedies often associated with schizophrenia. Schizophrenia has led to the breakdown of many families and relationships. Greg Bottoms in the book Angelhead: My Brother’s Descent into Madness powerfully explains the pain that the illness has brought upon him and his family.

On the bright side, with treatment there is hope for even the worst-case scenarios. I have witnessed firsthand the remarkable difference treatment can make in the lives of people with schizophrenia and their families. It can be transformational and inspirational. Treatment can save lives.

I would recommend that you enlist a therapist or another mental health professional with expertise in schizophrenia to assist you with this complex problem. If you have any additional questions, please feel free to write again. I will do my best to answer your questions or to recommend organizations or other resources that may be of assistance to you. I wish you the best. Please take care.

Dr. Kristina Randle